PUMPHTE# I oil Harnett County Department of Public Health
23810
PERMIT # to 9 ,/ Operation Permit
Id New Installation Septic Tank 2"Gitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION N
Name: (owner) �Di�ln- s� a�•`�C SUBDIVISION LOT #
System Installer: Z57is Registration #
Basement with plumbing: ❑ Garage C3'N stiffer of Bedrooms 3
Type of Water Supply:
El fes' Public ❑ Well Distance from well �� feet
System Type: "- Jn 3 y eT s V and VI Systems expire in S years.
(In accordance with able V a) Owner c c ea e a nt months prio to expiration for permit renewal.
This system has been installed in compliance with applicable Narth Carolina GenerAaltitutes, Rules for Sewage Treatment and Disposal, and all conditions of thillarpnovernent Permit and Construction Authorization,
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PERMIT CONDITIONS:
L Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2O1-ine
❑ PWR Line
Following are the specifications
for
the seewwsq, 4isposal system on the above captioned property.
Type of system: El
Conventional
Lel Othert u gjt* 4n 2S Vx
Septic Tank: / 11 d 6 gallons
Pump Tank: I " gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditchQ� _ feet
ditches �5 feet
ditches inches
French Drain Required:
Linear feet
Authorized State Agegs - � 1--" "lea � Date // -Z3 /—
. �_. ♦,
15-5-36811 (1) 15-5-36811 (2) 15-5-36811 (3) 15-5-36811 (4) 15-5-36811 (5)
ssss Y - a c
15-5-36811(6) 15-5-36811(7) 15-5-36811(8) 15-5-36811(9) 15-5-36811(10)
15-5-36811(11) 15-5-36811(12) 15-5-36811(13) 15-5-36811(14) 15-5-36811(15)
MV7-^J1�r`'� ' .}rddl i'.
15-5-36811(16) 15-5-36811(17) 15-5-36811(18) 15-5-36811(19) 15-5-36811(20)
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